Management of

Low Birth Weight

Babies

FBNC LBW- 1
 Low birth weight (LBW)

 Definition : Birth weight

<2500 g

 Incidence : 30% of neonates

in India

FBNC LBW- 2
 LBW: Significance

 75% neonatal deaths and 50% infant

deaths occur among LBW infants
 LBW babies are more prone to:
 Malnutrition
 Recurrent infections
 Neurodevelopmental delay

LBW babies have higher mortality and morbidity

FBNC LBW- 3
 Learning Objectives

 Classify types of LBW

 Identify physical features of preterm and
term
 Enumerate problems of preterm & SGA
 Chart fluid and feed requirements for a
sick LBW neonate
 Enumerate modes of enteral feeding for a
LBW neonate

FBNC LBW- 4
 Types of LBW
2 types based on the origin
Small-for-date (SFD) /
Preterm
intra uterine growth
retardation (IUGR)

 < 37 completed  < 10th centile for

weeks of gestation gestational age
 Account for 1/3rd of  Account for 2/3rd of
LBW LBW neonates

FBNC LBW- 5
 Causation: LBW

Etiology of prematurity

 Low maternal weight, teenage / multiple

pregnancy
 Previous preterm baby, cervical incompetence
 Antepartum hemorrhage, acute systemic
disease
 Induced premature delivery
 Majority unknown

FBNC LBW- 6
 Causation: LBW

Etiology of SFD / IUGR

 Poor nutritional status of mother

 Hypertension, toxemia, anemia
 Multiple pregnancy, post maturity
 Chronic malaria, chronic illness
 Tobacco use

FBNC LBW- 7
 LBW: Identification of types
Prematurity
 Date of LMP
 Physical features
 Breast nodule
 Genitalia
 Sole creases
 Ear cartilage / recoil
 Skin
 Hair
FBNC LBW- 8
 Preterm vs Term
Physical feature Preterm Term
Ear cartilage Soft & devoid of cartilage, Firm, cartilage present, easy to
difficult to recoil recoil
Breast Nodule <5mm >5mm

Sole Creases <anterior 1/3rd – skin creases > Anterior 2/3rd

External Genitalia-Male No rugae, testes not Rugae present & testis

descended descended
External Genitalia-Female Labia widely separated\, not Labia covering labia minora,
covering labia minora, and clitoris
prominent clitoris

Skin Thin, gelatinous, transparent Thick & keratinised

Hair Abundant fine hair- lanugo Less lanugo

FBNC LBW- 9
 LBW: Identification of types

SFD / IUGR
 Intrauterine growth chart

 Physical characteristics
 Emaciated look
 Loose folds of skin
 Lack of subcutaneous tissue
 Head bigger than chest by >3cm

FBNC LBW-10
 Intrauterine growth chart
4400

4000 90th percentile

LARGE FOR DATE
3600
Birth weight (grams)

3200
APPROPRIATE FOR DATE
2800

2400
10th percentile
2000

1600
SMALL FOR DATE

1200

800 PRETERM TERM POST-TERM

400
31 33 35 37 39 42 44 45
FBNC Gestation (weeks) LBW-11
 LBW (Preterm) : Problems

 Birth asphyxia  Retinopathy of

prematurity
 Hypothermia
 Apneic spells
 Feeding difficulties
 Intraventricular
 Infections
hemorrhage
 Hyperbilirubinemia
 Hypoglycemia
 Respiratory
distress  Metabolic acidosis

FBNC LBW-12
 SGA Neonates : Problems

Basic problem is in-utero undernutrition &

hypoxia
 Birth asphyxia

 Meconium aspiration syndrome

 Hypothermia

 Hypoglycemia

 Infections

 Congenital malformations
FBNC LBW-13
 LBW: Issues in delivery

 Anticipated LBW delivery should be

conducted in hospital
 In-utero transfer to a well-equipped
centre before delivery
 Skilled person needed for effective
resuscitation
 Prevention of hypothermia - topmost
priority
FBNC LBW-14
 LBW: Indications for
hospitalization

 Birth weight <1800 g

 Gestation <34 wks
 Unable to feed*
 Sick neonate*

* Irrespective of birth weight and gestation

FBNC LBW-15
 Nutrition and Fluids

 Fluids & nutrition of LBW depends on

birth weight, gestation and presence or
absence of sickness

 Breast milk is the most ideal feed for

LBW

 Ultimate goal is to get the nutrition from

direct exclusive BF
FBNC LBW-16
 LBW: Fluids and feeding

Weight <1200 g; Gestation <30 wks*

 Start initial intravenous fluids
 Introduce gavage feeds once stable
 Shift to katori-spoon feeds over next few
days. Later on breast feeds

* May try gavage feeds, if not sick

FBNC LBW-17
 LBW: Fluids and feeding

Weight 1200-1800 g; Gestation 30-34 wks*

 Start initial gavage feeds
 Katori-spoon feeding after 1-3 days
 Shift to breast feeds as soon as baby is
able to suck

* May need intravenous fluids, if sick

FBNC LBW-18
 LBW: Fluids and feeding

Weight >1800 g; Gestation > 34 wks*

 Breast feeding
 Katori-spoon feeding, if sucking not
satisfactory on breast
 Shift to breast feeds as soon as possible

FBNC LBW-19
 Guidelines for fluid requirements

 First day 60-80 ml/kg/day

 Daily increment 15 ml/kg till day 7

 Add extra 20-30 ml/kg for infants under

radiant warmer and 15 ml/kg for those
receiving phototherapy

FBNC LBW-20
 Fluid requirements (ml/kg)
Birth Weight
Day of life
>1500 g 1000 – 1500g
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170
FBNC LBW-21
 Techniques /Methods of Feeding

 Gavage feeding

 Katori-Spoon Feeding

 Breastfeeding

FBNC LBW-22
 Gavage Feeding-1
 Use 5-6 french size polyethylene feeding catheter
 Outer end of tube is attached to a 10 ml syringe ( without
plunger)
 Milk is allowed to trickle by gravity
 Place baby in the left lateral position for 15 to 20 minutes to
avoid regurgitation. There is no need to burp a gavage-fed
baby.
 Orogastric tube may be left in situ for 2 or 3 days.
 While pulling out a feeding tube, pinch and pull out gently to
avoid trickling of gastric mucus into the trachea.

FBNC LBW-23
 Gavage Feeding-2
 Gavage feeding may be risky in very small babies as they have
small stomach capacity & the gut may not be ready to tolerate
feeds.
 Gavage-fed babies are prone to regurgitation & aspiration,
hence it is important to take precautions during feeding.
 Before every feed, the abdominal girth (just above the umbilical
stump) should be measured. If the abdominal girth increases by
more than 2 cm from the baseline, the baby should be evaluated
for the cause of ileus.
 The feeds may have to be suspended till the abdominal
distension improves
 Routine Pre-feed Gastric Aspirates Are Not Recommended .
FBNC LBW-24
 Katori-Spoon Feeding-1
 Feeding with a spoon (or a similar device such as ‘paladai) &
katori (or any other container such as cup) is safe in LBW
babies.
 This mode of feeding is a bridge between gavage feeding &
direct breast feeding.
 30-32 weeks GA babies can swallow the feeds satisfactorily
even though they may not be good at sucking or coordinated
sucking & swallowing.
 Use a katori and a spoon. Both utensils must be washed,
cleaned and boiled.
 Take the required amount of expressed breast milk in the
katori. Place the baby in a semi-upright posture with a napkin
around the neck to mop up the spillage.

FBNC LBW-25
 Katori-Spoon Feeding-2
 Fill the spoon with milk, a little short of the brim, place it at
the lips of the baby in the corner of mouth

 Let the milk flow into the baby’s mouth slowly avoiding the
spill. The baby will actively swallow the milk.

 Repeat the process till the required amount has been fed.

 If the baby does not actively accept and swallow the feed,
try gentle stimulation.

 If he is still sluggish, do not insist on this method. It is better

to switch back to gavage feeds till the baby is ready.
FBNC LBW-26
 LBW: Judging Adequacy of
Nutrition

Weight pattern*
 Loses 1 to 2% weight every day initially
 Cumulative weight loss 10%; more in preterm
 Regains birth weight by 10-14 days
 Then gains weight up to 1 to 1.5% of birth
weight daily

Excessive loss or inadequate weight

 Cold stress, anemia, poor intake, sepsis

* SFD - LBW term baby does not lose weight

FBNC LBW-27
 LBW: Supplements
 Vitamins : IM Vit K 1.0 mg at birth
IM Vit K0.5mg,if B.wt <1kg
Vit A* 1000 I.U. per day
Vit D* 400 I.U. per day*
*From 2 weeks of age
 Iron :Oral 2 mg/kg per day from
6 weeks of age

 In VLBW babies- (<1.5kg,<32 wk) supplement

with Vit E, Calcium & Phosphorus
FBNC LBW-28
 Vaccinations

 Vaccination Schedule same as in normal

babies

 BCG & OPV should be given at the

earliest

 A sick LBW baby- should receive

vaccines only on recovery at discharge

FBNC LBW-29
 Prognosis

 Mortality
 Inversely related to birth weight and
gestation
 Directly related to severity of complications

 Long term
 Depends on birth weight, gestation and
severity of complications

FBNC LBW-30
 Evaluation

 Define Low birth weight. What proportion of

babies is LBW in our country?

 Enumerate 4 physical features that can help

differentiate a preterm from a term LBW.

 Enumerate problems of SGA LBW neonates

FBNC LBW-31
 Evaluation

 Mention the fluid requirement of a 1500 gm

baby on D6 of life?

 How will you initiate feeding in a 1400 gm

32 weeks gestation baby on D3 of life

FBNC LBW-32
 Acknowledgements

 Material for slides has been referred from

Teaching AIDS- NNF

FBNC LBW-33
 Thankyou
FBNC LBW-34